Skip to main content
Top
Published in: Journal of General Internal Medicine 7/2019

01-07-2019 | Acupuncture | Original Research

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

Authors: Stephanie L. Taylor, PhD, Katherine J. Hoggatt, MPH, Benjamin Kligler, MD, MPH

Published in: Journal of General Internal Medicine | Issue 7/2019

Login to get access

Abstract

Objectives

Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation’s largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients’ high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans’ interest in and use of CIH approaches.

Methods

Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans’ interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.

Results

In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.

Conclusions

Veterans report relatively high past-year use of CIH approaches and many more report interest in CIH approaches. To address this gap between patients’ level of interest in and use of CIH approaches, primary care providers might want to discuss evidence-based CIH options to their patients for relevant health conditions, given most CIH approaches are safe.
Literature
2.
go back to reference Qaseem A, Wilt TJ, McLean RM, Forciea M. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017;166(7):514–530.CrossRefPubMed Qaseem A, Wilt TJ, McLean RM, Forciea M. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017;166(7):514–530.CrossRefPubMed
3.
go back to reference Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clin Proc 2016 Sep;91(9):1292–306.CrossRefPubMedPubMedCentral Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clin Proc 2016 Sep;91(9):1292–306.CrossRefPubMedPubMedCentral
4.
go back to reference Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017;166(7):493–505.CrossRefPubMed Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017;166(7):493–505.CrossRefPubMed
5.
go back to reference Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA 2017;317(14):1451–1460.CrossRefPubMedPubMedCentral Paige NM, Miake-Lye IM, Booth MS, Beroes JM, Mardian AS, Dougherty P, Branson R, Tang B, Morton SC, Shekelle PG. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA 2017;317(14):1451–1460.CrossRefPubMedPubMedCentral
7.
go back to reference .Goode AP, Coeytaux RR, McDuffie J, Duan-Porter W, Sharma P, Mennella H, Nagi A, Williams JW. An evidence map of yoga for low back pain. Complement Ther Med 2016;25:170–7CrossRefPubMed .Goode AP, Coeytaux RR, McDuffie J, Duan-Porter W, Sharma P, Mennella H, Nagi A, Williams JW. An evidence map of yoga for low back pain. Complement Ther Med 2016;25:170–7CrossRefPubMed
8.
go back to reference Solloway M, Taylor SL, Miake-Lye IM, Beroes JM, Shanman R, Booth MJ, Siroka AM, Shekelle PG, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev 2016; 5(1):126.CrossRefPubMedPubMedCentral Solloway M, Taylor SL, Miake-Lye IM, Beroes JM, Shanman R, Booth MJ, Siroka AM, Shekelle PG, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev 2016; 5(1):126.CrossRefPubMedPubMedCentral
9.
go back to reference Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, Maglione MA. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med 2017;51(2):199–213.CrossRefPubMed Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, Maglione MA. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med 2017;51(2):199–213.CrossRefPubMed
11.
go back to reference Miake-Lye IM, Lee JF, Luger T, Taylor S, Shanman R, Beroes JM, Shekelle PG. Massage for Pain: An Evidence Map. VA ESP Project #05-226; 2016. Miake-Lye IM, Lee JF, Luger T, Taylor S, Shanman R, Beroes JM, Shekelle PG. Massage for Pain: An Evidence Map. VA ESP Project #05-226; 2016.
12.
go back to reference Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2016 ;315(12):1240–9. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2016 ;315(12):1240–9.
13.
go back to reference Morone NE, Greco CM, Moore CG, Rollman BL, Lane B, Morrow LA, Glynn NW, Weiner DK. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med 2016;176(3):329–37.CrossRefPubMedPubMedCentral Morone NE, Greco CM, Moore CG, Rollman BL, Lane B, Morrow LA, Glynn NW, Weiner DK. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med 2016;176(3):329–37.CrossRefPubMedPubMedCentral
14.
go back to reference Duan-Porter W, Coeytaux RR, McDuffie J, et al. Evidence Map of Yoga for Depression, Anxiety and Post-traumatic Stress Disorder. J Phys Act Health 2016;13(3):281–8.CrossRefPubMed Duan-Porter W, Coeytaux RR, McDuffie J, et al. Evidence Map of Yoga for Depression, Anxiety and Post-traumatic Stress Disorder. J Phys Act Health 2016;13(3):281–8.CrossRefPubMed
15.
go back to reference Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty, GJ, Collins RC, Rodman JL, Lim KO. Mindfulness-Based Stress Reduction for posttraumatic stress disorder among veterans: a randomized trial. JAMA 2015;314(5): 456–465.CrossRefPubMed Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty, GJ, Collins RC, Rodman JL, Lim KO. Mindfulness-Based Stress Reduction for posttraumatic stress disorder among veterans: a randomized trial. JAMA 2015;314(5): 456–465.CrossRefPubMed
16.
go back to reference Institute of Medicine (U.S.) Complementary and alternative medicine in the United States / Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention. Washington, DC: The National Academies Press, 2005. Institute of Medicine (U.S.) Complementary and alternative medicine in the United States / Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention. Washington, DC: The National Academies Press, 2005.
17.
go back to reference Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008;(12):1–23. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008;(12):1–23.
18.
go back to reference Cassileth BR, Lusk EJ, Strouse TB, Bodenheimer BJ. Contemporary, unorthodox treatment in cancer medicine: a study of patients, treatments and practitioners. Ann Intern Med 1984; 101:105–112.CrossRefPubMed Cassileth BR, Lusk EJ, Strouse TB, Bodenheimer BJ. Contemporary, unorthodox treatment in cancer medicine: a study of patients, treatments and practitioners. Ann Intern Med 1984; 101:105–112.CrossRefPubMed
20.
go back to reference Crane RS, Kuyken W. The Implementation of Mindfulness-Based Cognitive Therapy: Learning From the UK Health Service Experience. Mindfulness 2013;4:246–254.CrossRefPubMed Crane RS, Kuyken W. The Implementation of Mindfulness-Based Cognitive Therapy: Learning From the UK Health Service Experience. Mindfulness 2013;4:246–254.CrossRefPubMed
21.
go back to reference Ananth S. 2010 Complementary and Alternative Medicine Survey of Hospitals. Samueli Institute, Alexandria, VA. Available at: http://www.samueliinstitute.org/File%20Library/Our%20Research/OHE/CAM_Survey_2010_oct6.pdf Ananth S. 2010 Complementary and Alternative Medicine Survey of Hospitals. Samueli Institute, Alexandria, VA. Available at: http://​www.​samueliinstitute​.​org/​File%20Library/Our%20Research/OHE/CAM_Survey_2010_oct6.pdf
22.
go back to reference Ezeji-Okoye SC, Kotar TM, Smeeding SJ, Durfee JM. State of Care: Complementary and Alternative Medicine in Veterans Health Administration–2011 Survey Results. Fed Pract 2013; 14–19. Ezeji-Okoye SC, Kotar TM, Smeeding SJ, Durfee JM. State of Care: Complementary and Alternative Medicine in Veterans Health Administration–2011 Survey Results. Fed Pract 2013; 14–19.
23.
go back to reference Comprehensive Addiction and Recovery Act (CARA) of 2016. TITLE IX--DEPARTMENT OF VETERANS AFFAIRS. Subtitle C--Complementary and Integrative Health. Section 931. Expansion of research and education on and delivery of complementary and integrative health to veterans. Section 932. Expansion of research and education on and delivery of complementary and integrative health to veterans. Section 933. Pilot program on integration of complementary and integrative health and related issues for veterans and family members of veterans. Comprehensive Addiction and Recovery Act (CARA) of 2016. TITLE IX--DEPARTMENT OF VETERANS AFFAIRS. Subtitle C--Complementary and Integrative Health. Section 931. Expansion of research and education on and delivery of complementary and integrative health to veterans. Section 932. Expansion of research and education on and delivery of complementary and integrative health to veterans. Section 933. Pilot program on integration of complementary and integrative health and related issues for veterans and family members of veterans.
24.
go back to reference Lozier CC, Nugent SM, Smith NX, Yarborough BJ, Dobscha SK, Deyo RA, Morasco BJ. Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy. JGIM; 2018, 33 (Supp.1): 46–53. Lozier CC, Nugent SM, Smith NX, Yarborough BJ, Dobscha SK, Deyo RA, Morasco BJ. Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy. JGIM; 2018, 33 (Supp.1): 46–53.
25.
go back to reference Edmond SN, Becker WC, Driscoll MA, Decker SE, Higgins DM, Mattocks KM, Kerns RD, Haskell SG. Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain: Results from a Cross-Sectional Survey. JGIM; 2018, 33 (Supp.1): 54–60. Edmond SN, Becker WC, Driscoll MA, Decker SE, Higgins DM, Mattocks KM, Kerns RD, Haskell SG. Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain: Results from a Cross-Sectional Survey. JGIM; 2018, 33 (Supp.1): 54–60.
26.
go back to reference Wong ES, Wang V, Liu C-F, Hebert PL, Maciejewski ML. Do Veterans Health Administration Enrollees Generalize to Other Populations? Med Care Res Rev; 2015:1–15. Wong ES, Wang V, Liu C-F, Hebert PL, Maciejewski ML. Do Veterans Health Administration Enrollees Generalize to Other Populations? Med Care Res Rev; 2015:1–15.
27.
go back to reference Clark M, Bair MJ, Buckenmaier CI, Gironda R, Walker R. Pain and OIF/OEF combat injuries: implications for research and practice. J Rehabil Res Dev 2007;44:179–94.CrossRefPubMed Clark M, Bair MJ, Buckenmaier CI, Gironda R, Walker R. Pain and OIF/OEF combat injuries: implications for research and practice. J Rehabil Res Dev 2007;44:179–94.CrossRefPubMed
28.
go back to reference Lang KP, Veazey-Morris K, Andrasik F. Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans with Polytrauma Injuries. J Head Trauma Rehabil 2014;29(1):44–53..CrossRefPubMed Lang KP, Veazey-Morris K, Andrasik F. Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans with Polytrauma Injuries. J Head Trauma Rehabil 2014;29(1):44–53..CrossRefPubMed
29.
go back to reference Clark ME, Walker RL, Gironda RJ, Scholten JD. Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure. Pain Med 2009;10(3):447–55.CrossRefPubMed Clark ME, Walker RL, Gironda RJ, Scholten JD. Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure. Pain Med 2009;10(3):447–55.CrossRefPubMed
30.
go back to reference Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. National Health Statistics Reports; no 79. Hyattsville, MD: National Center for Health Statistics. 2015.
31.
go back to reference Taylor SL, Herman PM, Marshall NJ, Zeng Q, Yuan A, Chu K, Shou Y, Morioka C, Lorenz K. Use of Complementary and Integrated Health: A Retrospective Analysis of by U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med 2018 Oct 12. doi: https://doi.org/10.1089/acm.2018.0276. [Epub ahead of print] Taylor SL, Herman PM, Marshall NJ, Zeng Q, Yuan A, Chu K, Shou Y, Morioka C, Lorenz K. Use of Complementary and Integrated Health: A Retrospective Analysis of by U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med 2018 Oct 12. doi: https://​doi.​org/​10.​1089/​acm.​2018.​0276. [Epub ahead of print]
32.
go back to reference Clark DJ. Chronic Pain Prevalence and Analgesic Prescribing in a General Medical Population. J Pain Symp Mgmt February 2002Volume 23, Issue 2, Pages 131–137. Clark DJ. Chronic Pain Prevalence and Analgesic Prescribing in a General Medical Population. J Pain Symp Mgmt February 2002Volume 23, Issue 2, Pages 131–137.
33.
go back to reference Kerns RD, Dobscha SK. Pain among veterans returning from deployment in Iraq and Afghanistan: update on the Veterans Health Administration Pain Research Program. Pain Med 2009;10(7):1161–4.CrossRefPubMed Kerns RD, Dobscha SK. Pain among veterans returning from deployment in Iraq and Afghanistan: update on the Veterans Health Administration Pain Research Program. Pain Med 2009;10(7):1161–4.CrossRefPubMed
34.
go back to reference Taylor SL, Giannitrapani K, Yuan A, Marshall N. What Patients and Providers Want to Know About Complementary and Integrative Health Therapies. J Altern Complement Med 2018. Jan;24(1):85–89.CrossRefPubMed Taylor SL, Giannitrapani K, Yuan A, Marshall N. What Patients and Providers Want to Know About Complementary and Integrative Health Therapies. J Altern Complement Med 2018. Jan;24(1):85–89.CrossRefPubMed
Metadata
Title
Complementary and Integrated Health Approaches: What Do Veterans Use and Want
Authors
Stephanie L. Taylor, PhD
Katherine J. Hoggatt, MPH
Benjamin Kligler, MD, MPH
Publication date
01-07-2019
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 7/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-04862-6

Other articles of this Issue 7/2019

Journal of General Internal Medicine 7/2019 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.